- Frank haematuria - urine that is visibly red/brown. This is always urgent.
- Microscopic haematuria - urine that isn't visibly red, but on analysis/dipstick shows a small content of blood.
Relatively common, especially in older people. Its a good predictor for serious disease - in one study of 50+ men, pathological conditions were found in 31 out of 44 who had haematuria at least once.
Its almost always a problem in the urinary tract. Blood is a massive molecule, so no matter how nackered the kidneys are, they won't let blood through. So the blood comes through somewhere between the kidney and the urethra.
Clinical and Associated Features
Simple version: TITS - Trauma Infection Tumour Stones.
- Renal calculi - stones cause loin pain, and damage the ureters, causing blood.
- Urinary tract infection - commonly present with fever, general malaise and in the older generation, commonly delirium.
- Urinary tract malignancy - Not massively common, but serious.
- Glomerulonephritis - also accompanied with kidney pain, and with lack of urinating. Often systemically unwell too.
- Bleeding disorders - anticoagulants can also cause it.
- Rhabdomyolysis - this is pretty rare, but on someone with recent physical trauma, clots or immobility, pink urine should be an alarm bell!
- Acute intermittent porphyria - also pretty rare, but if you leave their wee to stand, it goes brown/red, sometimes being mistaken for haematuria.
Kick off with Urinalysis. This is mandatory to confirm there is actually blood in the urine.